DEAR DR. DONOHUE: After shampooing my hair, I looked in the mirror and found a large bald patch near my ear. I screamed. I can comb my hair to hide it. Does this mean I am about to lose all my hair? Is there a treatment for it? — A.A.

ANSWER: With a fair degree of confidence, I can say you have alopecia areata, bald patches that vary in size and number. Close to 4.5 million American adults and children suffer from this condition every year. Like so many other illnesses, it’s the result of an immune system gone berserk. The immune system attacks hair follicles, the skin pores that are homes for each hair. What turns on the immune system to do this is something that waits to be discovered.

As heartbreaking as alopecia areata is in the short run, there is high hope of complete restoration of hair in time. Around 50 percent will have hair regrowth within a year even if no treatment is given.

Treatments exist to speed the healing process. One is injection of a high-potency cortisone drug, like triamcinolone, into the bald patch. Another treatment consists of applying an allergen directly to the bald spots. The reaction it produces leads to hair regrowth. The allergen often chosen is DPCP, diphenylcyclopropenone. These are only two of the options open to alopecia areata patients.

Hair follicles retain the capacity to regenerate.

Complicated alopecia areata can affect the entire scalp and body hair. These are not common instances, when you consider the entire population of sufferers of this malady.

If you like more detailed information, contact the National Alopecia Areata Foundation on line at www.naaf.org.

DEAR DR. DONOHUE: Will you please discuss a condition called vulvodynia? I am a 62-year-old woman who was diagnosed with the condition 18 years ago. I was put on the medication amitriptyline and was symptom-free for 18 years.

Recently I had a urinary tract infection and was given sulfa for it. The amitriptyline stopped working. My symptoms have returned. My doctor has me on gabapentin. I am told it takes about six weeks for this medication to take effect. — B.L.

ANSWER: Vulvodynia is pain in the external genitals of the female genital tract. A tampon, cotton swab, tight jeans and sexual contact are some of the things that trigger the pain. Some women have chronic pain in this area without any trigger. It’s a most unpleasant condition that disrupts a woman’s life.

A low dose of estrogen cream or vaginal estrogen tablets (Vagifem) often can control symptoms. The warnings to postmenopausal women about estrogen complications have to be given. But at low doses, rarely does it lead to serious trouble. Little of the estrogen enters the blood. Gabapentin is another medicine that often is prescribed. Your medicine ought to be taking hold soon. Gabapentin also comes as a gel or cream applied directly to the painful area. Lidocaine gel is another pain reliever used for treatment of vulvodynia.

What complicates vulvodynia is the inability to find what causes it.

The National Vulvodynia Association can provide women with valuable information on this not-uncommon condition. The website is www.nva.org. Even if you don’t have computer, a friend or relative with their computer can provide you a look at what the association can offer you.

DEAR DR. DONOHUE: What is the difference between chronic kidney disease and chronic kidney failure? — B.K.

ANSWER: Chronic kidney disease includes a large number of kidney illnesses that aren’t curable but often are controllable, so the kidneys don’t actually fail. They still work.

Chronic kidney failure is the end result of kidney illnesses that have brought about nonfunctioning of the kidneys. A transplant or dialysis is the treatment for kidney failure.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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